Provider Demographics
NPI:1073630117
Name:ELM CITY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ELM CITY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THEZLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALPIZAR-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-848-1599
Mailing Address - Street 1:419 WHALLEY AVE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3019
Mailing Address - Country:US
Mailing Address - Phone:203-848-1599
Mailing Address - Fax:203-848-1603
Practice Address - Street 1:419 WHALLEY AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3019
Practice Address - Country:US
Practice Address - Phone:203-848-1599
Practice Address - Fax:203-848-1603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty